Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study

Abstract

Objective: Complications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997-2007.

Research design and methods: All individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.

Results: The relative risk for the first major amputation was 7.4 (95% CI 7.2-7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.

Conclusions: In our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.

Figure 1

Standardized incidence (log scale) of the first major amputation per 100,000 person-years among individuals with diabetes in Finland 1997–2007. Non-DM, individuals without diabetes.

Figure 2

Cumulative 5-year mortality (percentage) after the first major amputation among individuals with diabetes: A: men and women according to age-groups <65 years, 65–75 years, and >75 years; B: in relation to the subgroup of diabetes; C: in relation to the amputation level (below the knee or above the knee).